Provider Demographics
NPI:1184849747
Name:AHDAB, TAREK MOHAMAD (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:TAREK
Middle Name:MOHAMAD
Last Name:AHDAB
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:DR
Other - First Name:MOHAMAD
Other - Middle Name:TAREK
Other - Last Name:ALAHDAB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:29624 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8201 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-2300
Practice Address - Country:US
Practice Address - Phone:815-971-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105726202K00000X, 207RC0000X, 207UN0901X, 2085R0204X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH65174OtherUPIN
ILL92325OtherPROVIDER NUMBER
ILIL1648002Medicare PIN
ILL92325OtherPROVIDER NUMBER
ILH65174Medicare UPIN
ILIL7368001Medicare UPIN